Game Changing Surgery: Building A Pain-Free Athlete - NewsChannel5.com | Nashville News, Weather & Sports

Game Changing Surgery: Building A Pain-Free Athlete

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ATLANTA, Ga. ( Ivanhoe Newswire) - Everyday thousands of people are benched due to an injury. But you don't have to play through the pain any more.

Too much, too hard, too fast. Millions of weekend warriors will end up at the doctor's office this year.

"It was at first the most excruciating pain I've ever felt really," Tim Acevedo, a cyclist, told Ivanhoe.

"I couldn't walk at all without severe pain," Gary Stearns, an avid runner, said.

Backs, knees, shoulders, ACL's, hips, all pushed to the extreme and exhausted! Tim Acevedo was more comfortable on two wheels than two feet until the competitive cyclist was literally thrown off his game.

"I was coming down a hill and I hit a bump that I didn't see so it threw me up in the air and I landed on my shoulder, my hands landed first and that popped the shoulder," Acevedo explained.

"Number one, the bone breaks, and number two the coraclavicular ligaments tear," Spero Karas, M.D., head team physician for the Atlanta Falcons and associate professor of orthopedics at Emory Sports Medicine, explained.

Traditional suture repair failed just one week after surgery, then Tim met doctor Karas, one of the only U.S. surgeons doing clavicle repair with a European device called a sub-acromial hook plate.

"It goes underneath the acromium and actually pushes the clavicle back down," Dr. Karas said.

Implanted during surgery, studies show the hook plate stabilizes the joint during healing. Three months post-op, Tim's shoulder was stable enough to remove the plate. Now, he's back on two wheels.

"My shoulder is very relaxed, my range of motion has increased tremendously and the strength is coming back quickly as well," Acevedo said.

It probably won't be Tim's last sports injury. In fact, cycling, running, tennis and golf are the sports with the most injuries for people over 40. From avid athletes to those who work out just a few times a week, our knees take the most abuse. The average knee bends about five-thousand times a day. Add running five miles, three times a week and that adds up to 1.7 million knee bends a year. That's why half of all 45-year-olds will end up with a knee problem before they're 65.

"My knee got really painful when I was walking or hiking," Gary Stearns, an avid runner, said.

If there's a 14,000 foot mountain anywhere in the U.S., Gary Stearns has seen the top of it.

"There's a real feeling of accomplishment," Stearns said.

But arthritis in his right knee stopped this avid mountain climber in his tracks. Traditionally, doctors would replace the entire joint, but now orthopedic surgeons are turning to a partial knee replacement. The outpatient partial knee replacement surgery is shorter and less invasive than a total knee.

"Now I just treat the arthritis. I basically take minimal bone from both the thigh bone or femur and tibia or shinbone and replace it with metal, cement and plastic," Grant Garlick, M.D., from the Florida Orthopedic Institute said.

Patients are able to walk without crutches or a cane two weeks after surgery. Six months after surgery, Gary was able to climb without pain. Now there is nothing stopping this climber or a cyclist, or you from pushing your limits pain free.

For tennis fanatics, researchers at Stanford have developed a surgical alternative for tendinitis using your own blood. Doctors take blood from a healthy part of your body, process it to boost platelet content and inject it into the affected area in the elbow kick starting the healing process. The result is 93% success rate equal to surgery, but without the knives.

RESEARCH SUMMARY

BACKGROUND: Orthopedic surgeons are using new procedures available for athletes who severely injure themselves. These procedures result in a pain free athlete. The surgeries are aimed at helping athletes who have shoulder, knee, and elbow problems.

SHOULDER:

  • SUB-ACROMIAL HOOK PLATE- The clavicle hook plate provides a single solution for fixation of both lateral clavicle fractures and acromioclavicular joint injuries. The plate and screw construct allows early rotational mobility of the shoulder (Source: shoulderdoc.co.uk).
    The plate stabilizes the joint during healing. As long as it is healing the athlete will become stronger faster.
  • PLATELET RICH PLASMA- For athletes who have tendonitis and arthritis in shoulders, elbows, or knees, they can inject their own blood into problem area instead of having surgery. The blood is injected into the damaged tissue. Blood is made of RBC (Red Blood Cells), WBC (White Blood Cells), Plasma, and Platelets. Platelets release healing proteins called growth factors. They mostly generate tissue and wound healing. When the platelets are increased in concentration, they can dramatically heal the problem. This makes the healing time shorter and allows athletes to become pain free (Source: orthohealing.com).

KNEE:

  • PARTIAL KNEE REPLACEMENT- If the knee is not completely damaged, more orthopedic surgeons are leaning towards partial knee replacement for athletes. The doctors remove damaged tissue and bone in the knee joint and replace the area with a man-made implant. They can replace just the damaged area of the knee that will result in shorter recovery times. Most patients go home the day of surgery and are able to walk without a cane or crutches three to four weeks after surgery (Source: nlm.nih.gov/medlineplus).

INTERVIEW

Dr. Grant Garlick, Orthopedic Surgeon affiliated with USF, discusses the difference between partial knee surgery and total knee surgery.

Why would someone need a knee replacement and why would somebody only need a partial knee replacement?

Dr. Garlick: People need knee replacements when arthritis particularly on the inside of the knee gets to a point where it interferes with their activities of daily living. Where the things in life that they enjoy doing such as working out, walking, tennis, skiing whatever is their hobbies. And what happens they start taking medication, anti-inflammatory medications or have some physical therapy and the pain remains. Sometimes we'll inject them with cortisone however it still interferes with their activities. It's present in the morning, they have stiffness when they wake up and it really inhibits what they can do. It limits their ability to walk, exercise and do the things in life that they enjoy doing. Now knee replacements really what you think of with a knee replacement is replacing the entire joint and what we've found is that the majority of the arthritis is on the inside or interior of the joint so we just treat the arthritis that's there. We used to actually cut out some of the bone, cartilage that was normal on the outside of the knee as well as underneath the knee cap but now we just treat the arthritis. I tell my patients all the time, I say well if you bring your car in and you have one bald tire don't replace all four just replace what needs to be replaced.

What do you do in the procedure then?

Dr. Garlick: I basically make a small incision on the interior or inner aspect of the knee and I basically take minimal bone from both the thigh bone or femur and tibia or shin bone and replace it with metal, cement and plastic. So it's a minimally invasive procedure, short operative time, very little blood loss and people are typically back to normal activity faster than with a total knee.

Why might this be a better choice for a patient than a full knee replacement?

Dr. Garlick: What happens with a full knee replacement there's four major ligaments around the knee and those ligaments work in concert in order to help your knee track appropriately. In order to get a total knee in, and it's a good surgery for the right patient, in order to get a total knee in you have to resect at least one or two of those ligaments. When you resect those ligaments although the knee tracks appropriately it doesn't track normally. So if we can leave all of those ligaments alone and just replace the bone that's arthritic, we leave the ligaments alone the knee ranges deeper and better to get more motion and their knee tracks normally.

Is there an ideal patient for the partial knee and is the door still open to come back and do a total knee if they need that later?

Dr. Garlick: We don't like to do knee replacements in very young or very old. We had a guy the other day that was ninety five years old he said, doc I'm finally ready for my knee replacement. I said no let's manage you with medication and injections. Of course on the flip side I had one person in their twenties they wanted a knee replacement, absolutely not. So really with the baby boomers now we're finding knee arthritis happening around the fifties, late forties. I try to get people in to their fifties before they even discuss knee replacement. Ideally when someone's active, someone that has gone through conservative management and someone that understands what they need to do after surgery. And the ideal patient for the partial is really pain on one side of the joint, specifically the interior of the joint. The case about converting it to a total later on, physiologically I look at patients in between fifty and eighty, to me their candidates for knee replacement if they meet the selection criteria. I don't say you're too old for a partial or you're too young for a partial or visa versa on the total. It's a different surgery to me it's a different disease process. With the total people that need a total, need a total. People that need a partial they should be treated with a partial because it's a different disease process. After a partial I do this as definitive treatment. The results at twenty years are nearly ninety percent or greater. So I'm not saying this is a temporary solution to your problem we can convert it to a total later on. I haven't had to convert one I have had someone come in to my office that had a partial that shouldn't have had a partial that I've revised to a total. But my own if you're careful selecting patients it's really a wonderful surgery.

Is the partial knee sort of a new approach?

Dr. Garlick: Back in the seventies is when they first tried to do it. Now the material that we use as well as the surgical technique has really flourished in the past three to five years. It's really caught on in the last three to five years. There were a couple of very famous total joint surgeons that basically said no to the partial and it lost favor in the eighties and in to the nineties. Now really over the past three to five years it has flourished. Not every surgeon does it, surgeons that are trained in knee replacement surgery again it's becoming in vogue. When I did my fellowship and advanced training in knee surgery it was roughly three and a half years ago, I didn't do one partial during my fellowship. Now I do about thirty percent of my cases as partial and some of my partners that did not do it then actually are starting to do it now.

Tell me again the advantages over a full knee replacement if you don't need it.

Dr. Garlick: Less surgery, smaller incision, less blood loss, greater motion, your knee tracks normally and you can have it as an outpatient procedure. I'm actually doing it in the surgery center you come in like a knee arthroscopy. You come in, my surgery takes about forty to forty five minutes and you're home in a couple of hours. You don't need to be in a hospital and it lessens your chance of a nosocomial or hospital acquired infection. You're in the comfort of your own home that night with a nurse there and doing physical therapy.

FOR MORE INFORMATION, PLEASE CONTACT:

Spero G. Karas, MD
Head Team Physician- Atlanta Falcons
Associate Professor of Orthopedics
Emory Healthcare Sports Medicine
skaras@emory.edu

Angela Davis
Florida orthopedic institute
(813) 978-9700 ext 7340

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